Incontinence, back pain can be alleviated

When people with urinary incontinence or low-back pain avoid seeking treatment, either because of a busy schedule or embarrassment, they are choosing to live with conditions that can often be alleviated or cured without surgery or pills.

That's the message physical therapists plan to share with callers on Saturday during the monthly Deseret News/Intermountain Healthcare Hotline, which runs from 10 a.m. to noon. For questions about either condition, call toll free at 1-800-925-8177.

Questions also may be e-mailed to [email protected] from 10 a.m. to 5 p.m. on Saturday. Answers to e-mails will be posted on the newspaper's Web site next Friday.

Jake Magel, director of the Intermountain Orthopedic and Spine Therapy Clinic at Intermountain Medical Center, and fellow physical therapist Susan McLaughlin will be available to answer questions about both topics.

McLaughlin said from 10 percent to 40 percent of people will deal with incontinence — an involuntary leakage of urine — at some point, with those in midlife more at risk. Stress incontinence is due to lack of muscle support and usually occurs when patients cough, sneeze, laugh or jump. Urge incontinence occurs when patients have a strong, constant urge to urinate and the leakage is triggered as they get close to a bathroom or hear water running. She said it's common for many people to have both types.

Though physical therapy is often effective in dealing with the condition, most people head straight to the urologist when they finally decide to deal with the problem. Many postpone addressing the issue out of embarrassment or the hope that it will subside on its own, she said.

And relatively few people understand that it can be treated without pills or surgery.

"All the studies around physical therapy and getting individualized treatment show muscle strengthening should be first line of defense. We would like to see more urologists referring people to us first," she said.

While both medication and surgery are effective in treating the condition, at least for a time, physical therapy is often less invasive and just as effective, though it takes dedication to daily exercises, she said.

In treating patients, McLaughlin helps them understand how to perform pelvic floor exercises that strengthen the muscles that control leakage from the bladder. "These are the muscles you use when you're in a public place and need to pass gas and you draw in and lift." The muscles are also used to stop urination in midflow, she said.

Some patients tell her a doctor has recommended pelvic floor or "Kegel" exercises. "They tell me they've been doing them for years but they're not helping." The problem in that case, she said, is that patients are doing them wrong, which actually makes the problem worse rather than correcting it.

To determine how strong the muscles are, McLaughlin uses a one-finger exam to assess the strength of pelvic floor muscle contraction and to see how long patients can maintain the contraction. She then teaches them how to build muscle endurance, working two different parts of the muscle system.

She also uses a bio-feedback system, which senses the activity of the muscles so patients can see on a screen how well they are contracting and can make adjustments accordingly. "It's a good tool to help re-educate them about how to use their muscles correctly."

Patients build muscle strength and endurance at home as they do daily exercises, usually from 60 to 80 repetitions per day.

Generally patients see the therapist once a week for two or three weeks, then the visits are spaced further apart. McLaughlin said most people require a total of six visits but must maintain their exercise schedule for several weeks or months to see real improvement, just as with any other muscle group, she said.

"It's easier to take a pill because this takes commitment, and people will only improve if they are doing the exercises." Young mothers with children sometimes opt for surgery even if they know about physical therapy, she said, because they can't find time to do the exercises.

Yet surgery "doesn't permanently repair" the problem. "The muscles and connective tissue become weak again over time, and going through menopause thins out the tissue."

McLaughlin is hopeful that patients thinking about medication or surgery will learn they have another option.

"People come in all the time and say 'I didn't know you could do physical therapy for this.' The whole pelvic area has been kind of a no-no to talk about," despite the fact that physical therapists have been treating incontinence since the 1980s, she said. "We need to do a better job of educating people."